Health Care Insurance

The Program
The University provides medical-surgical/health care insurance programs through Highmark Delaware and Aetna. Full-time employees, as well as visiting faculty and visiting professional personnel classifications are eligible to participate. (See "Costs" section below.)

When to Apply
Employees must apply for coverage within thirty days of employment, and the benefit goes into effect the first of the following month. If employees do not enroll during the first thirty days of employment, they must wait for the annual enrollment in the month of May to apply for coverage which will be effective July 1.
Exception: You may change your level of coverage upon a "life event" such as marriage, divorce, birth of child, death of spouse. Employees must notify Human Resources-Benefits by completing a Family Status and Benefits Change Form within 30 days of the family status change event.

Costs
The University funds the major portion of health insurance premiums for eligible employees. The cost to each employee depends upon the plan selected and the percentage of time worked. Effective July 1, 2012, there is a fixed cost share established for each of the health plans offered through the State of Delaware. As a result the University pays 96% of the total cost of the First State Basic Plan, 95% of the total cost of Highmark Delaware CDH Gold or Aetna CDH Gold Plans, 93.5% of the total cost of for the Aetna or Highmark Delaware IPA/HMO Plans, and 86.75% of the total cost of the Comprehensive PPO Plan.

Note: A full-time University employee (married prior to January 1, 2012 to another full-time University employee, State employee, or University retiree) who is enrolled in a University health care plan, will pay $25 per month per contract (or the applicable employee-only premium, if enrolled in an employee-only plan for which the employee share of the premium is less than $25 per month). The same Double State Share rules apply to any University retiree married to another University retiree. Double State Share is not available for anyone who was not eligible for Double State Share prior to January 1, 2012. Options
Insurance options include two PPO (Preferred Provider Organizations) plans. HMO (Health Maintenance plans) and two CDH Gold (Consumer Directed Health) Plans that include an HRA (health reimbursement account). The HMO Plans require primary care physicians who direct your health care services. In addition, you must obtain all services and supplies from pre-approved health care providers.

Spousal Coordination
All medical plans have a coordination of benefits requirement if your spouse works full-time, is eligible for medical coverage through his/her employer, and does not pay more than 50% of the premium for the least expensive employee only benefit plan available (flexible benefits and credits apply towards employer's contribution).

If your spouse is eligible and does not enroll in his/her employer's medical plan, the University coverage will pay only 20% of the eligible expenses normally covered.

Note: If a spouse obtains medical coverage through his/her employer, you may either continue or cancel University coverage for your spouse. You must notify the Office of Human Resources by completion of a Family and Benefit Status Change Form within 30 days of the effective date of the spouse's coverage with his/her employer.

Spousal Coordination does not apply to:

Spouses not working full-time

Spouses whose employers do not offer medical coverage

Spouses whose employers require a contribution of more than 50% of the premium for the lowest benefit plan available

Spousal Coordination of Benefits when your spouse is retired: Spouses who are retired or will retire from an employer who offers retiree health insurance coverage are required to enroll in their employer’s retiree health plan under certain circumstances. Coverage with the University may be elected as secondary in those cases. Requirements for your spouse to enroll in their employer’s retiree health insurance coverage are as follows:

If your spouse’s current employer offers retiree health insurance coverage and your spouse is eligible for this coverage and does not have to pay more than 50 percent of the total monthly premium, your spouse is required to enroll in the employer’s retiree health plan at the time of retirement.

If your spouse retired before July 1, 2011, is eligible for retiree health insurance coverage through their prior employer, but chose not to enroll upon retirement, your spouse is required to enroll in the retiree health plan at the prior employer’s next open enrollment period.

If your spouse retired before July 1, 2011 and the prior employer does not allow enrollment in the retiree insurance coverage if not chosen upon retirement, your spouse is not required to enroll in the employer’s retiree health plan.

Upon Separation
Should an employee separate from the University, he or she may continue membership by paying premiums directly to the Insurance Carrier (under COBRA regulations) or by transferring coverage to another employer.